Study looks at skills of aging surgeons

Lots of work seen as a good way to keep them sharp

CHICAGO -- Most of Dr. Marshall Goldin's medical school classmates have retired or died, but at age 67, the heart surgeon believes he still has good working years ahead.

He performs about 200 heart and vascular surgeries a year at Rush University Medical Center. He has given away two sets of golf clubs because he doesn't have time to play that often.

"If one is still interested and enjoys the work and the challenge, it's my opinion that one should and can continue," Goldin said. "I don't believe my stamina and interest have at all changed."

Stamina, strength, fine motor skills and sharp eyesight are traits associated with youth -- and with surgery. The United States requires airline pilots to step down at age 60, but there is no mandatory retirement age for surgeons, who -- like pilots -- hold life in their hands.

A new study raises questions about when older surgeons should quit the operating room and how they can stay at the top of their game in the final years of their careers. With the percentage of working doctors older than 65 climbing, the questions hold growing importance for patients.

Previous studies found that older doctors are less likely to know about new treatments and medications than younger doctors, and they tend to perform worse on recertification exams.

The new study, published in the September Annals of Surgery, found that for three complicated surgeries, including heart bypass, doctors older than 60 had higher patient death rates, especially if they didn't do very many of the surgeries.

Some doctors nearing retirement reduce their caseloads, but the study suggests that's not a good idea.

Practice keeps skills high, so an all-or-nothing approach to surgery in the preretirement years may be better than gradually fading away, said study co-author Dr. John Birkmeyer of the University of Michigan.

"Those who continue to practice in high-risk areas should maintain their caseloads, but it may be a good idea when surgeons get into the preretirement mode that they give up the most complicated and high-risk surgeries altogether," said Birkmeyer, who is 43.

Patients should ask how many procedures a surgeon does a year, rather than focus on the doctor's gray hair, Birkmeyer said.

The best hospitals monitor surgeons' rates of complications, infections, readmissions to the hospital and deaths -- and use those statistics to confront doctors about a pattern of problems. Hospitals rely, too, on surgeons passing recertification exams every 10 years, but those tests gauge knowledge, not physical skills or technical mastery.